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Childhood-Onset Fluency Disorder
DSM-III In DSM-III, this disorder is called Stuttering Diagnostic Criteria Frequent repetitions or prolongations of sounds, syllables, or words or frequent, unusual hesitations and pauses that disrupt the rhythmic flow of speech. Differential Diagnosis Spastic dysphoria Spastic dysphoria, a stuttering-like speech disorder, is distinguished from Stuttering by the presence of an abnormal pattern of breathing. Cluttering Cluttering, in which there is such a rapid rate of speech that fluency breaks down, may suggest Stuttering, but in cluttering the individual is usually unaware of the disturbance, whereas in Stuttering, after the initial phase, the individual is painfully aware of the disturbance. DSM-IV In DSM-IV, this disorder is called Stuttering Diagnostic Criteria A'''. Disturbance in the normal fluency and time patterning of speech (inappropriate for the individual's age), characterized by frequent occurrences of one or more of the following: # sound and syllable repetitions # sound prolongations # interjections # broken words (e.g., pauses within a word) # audible or silent blocking (filled or unfilled pauses in speech) # circumlocutions (word substitutions to avoid problematic words) # words produced with an excess of physical tension # monosyllabic whole-word repetitions (e.g., "I-I-I-I see him") '''B. The disturbance in fluency interferes with academic or occupational achievement or with social communication. C'''. If a speech-motor or sensory deficit is present, the speech difficulties are in excess of those usually associated with these problems. '''Note: If a speech-motor or sensory deficit or a neurological condition is present, record the condition. Differential Diagnosis Sensory deficits and speech-motor deficits Speech difficulties may be associated with a hearing impairment or other sensory deficit or a speech-motor deficit. In instances where the speech difficulties are in excess of those usually associated with these problems, a concurrent diagnosis of Stuttering may be made. Normal dysfluencies Stuttering must be distinguished from normal dysfluencies that occur frequently in young children, which include whole-word or phrase repetitions (e.g., "I want, I want ice cream"), incomplete phrases, interjections, unfilled pauses, and parenthetical remarks. DSM-5 Diagnostic Criteria A'''. Disturbances in the normal fluency and time patterning of speech that are inappropriate for the individual's age and language skills, persist over time, and are characterized by frequent and marked occurrences of one (or more) of the following: # Sound and syllable repetitions. # Sound prolongations of consonants as well as vowels. # Broken words (e.g., pauses within a word). # Audible or silent blocking (filled or unfilled pauses in speech). # Circumlocutions (word substitutions to avoid problematic words). # Words produced with an excess of physical tension. # Monosyllabic whole-word repetitions (e.g., "I-I-I-I see him"). '''B. The disturbance causes anxiety about speaking or limitations in effective communication, social participation, or academic or occupational performance, individually or in any combination. C'. The onset of symptoms is in the early developmental period. ('Note: Later-onset cases are diagnosed as adult-onset fluency disorder.) D'''. The disturbance is not attributable to a speech-motor or sensory deficit, dysfluency associated with neurological insult (e.g., stroke, tumor, trauma), or another medical condition and is not better explained by another mental disorder. '''Differential Diagnosis Sensory deficits Dysfluencies of speech may be associated with a hearing impairment or other sensory deficit or a speech-motor deficit. When the speech dysfluencies are in excess of those usually associated with these problems, a diagnosis of childhood-onset fluency disorder may be made. Normal speech dysfluencies The disorder must be distinguished from normal dysfluencies that occur frequently in young children, which include the whole-word or phrase repetitions (e.g., "I want, I want ice cream"), incomplete phrases, interjections, unfilled pauses, and parenthetical remarks. If these difficulties increase in frequency or complexity as the child grows older, a diagnosis of childhood-onset fluency disorder is appropriate. Medication side effects Stuttering may occur as a side effect of medication and may be detected by a temporal relationship with exposure to the medication. Adult-onset dysfluencies If onset of dysfluencies is during or after adolescence, it is an "adult-onset dysfluency" rather than a neurodevelopmental disorder. Adult-onset dysfluencies are associated with specifiec neurological insults and a variety of medical conditions and mental disorders and may be specified with them, but they ar enot a DSM-5 diagnosis. Tourette's disorder Vocal tics and repetitive vocalizations of Tourette's disorder should be distinguishable from the repetitive sounds of childhood-onset fluency disorder by their nature and timing.